Using an SNS

Using an SNS (Supplemental Nursing System)

The below information aims to help improve your baby's milk intake at the breast, reducing or eliminating the need for bottle supplements until breastfeeing and supply improve

The information here is written for a generic audience, and all information may not be appropriate for you - please refer to your personalised plan and contact Heidi Hembry IBCLC if further clarification is needed.

An SNS (Supplemental Nursing System) can be used to encourage a bottle-fed baby to the breast and has the added benefit of increasing mum's milk supply too.
It can also be a great tool to support babies with tongue ties/oral restrictions feed better whilst waiting for assessment and treatment
Feeding at the breast should be prioritised where it is effective and the SNS introduced when feeding becomes slow and ineffective. For some babies it may necessary to introduce the SNS at the start of the feed.
Baby continuing to take a supplemental feed at the breast via the tube means s/he will get some additional milk directly from the breast, as well as stimulating more prolactin (your milk-producing hormone) as s/he feeds, further increasing your supply.
It can reduce the work of “breast - then - bottle”, and in addition greatly change the emotional dynamic of breastfeeding for mum and baby.
The 'uncapped' end of the tube needs to be at the bottom of the bottle, covered with milk. The other end needs to be at your nipple, extending about 1cm beyond your nipple, ensuring that both/any holes in the tube are well inside baby's mouth. Most babies work well with the tube in the corner of their mouths. Others prefer it under their top lip away from their tongue and a few will be quite happy to have it placed on their tongue - find out which works best for you and your baby.
For some families where latching is challenging, nipple shields may be helpful. Sometimes the tube can be placed inside the shield if latch and suctions are secure. Otherwise you may find you need to insert it in the corner of baby's mouth after latching to the shield - again, ensuring that any holes in the end of the tube are well inside baby's mouth
The tube can be held in place with a little medical tape/plaster on your breast - you may not need this as you and baby get the hang of it.
An SNS is simply a syphon, so you can control the flow well to suit you and your baby. Holding the bottle higher than baby’s mouth height means the milk will flow rapidly. Holding at mouth height will give a neutral flow, and holding lower will mean s/he has to work harder to keep the milk flowing. Initially, you may need to start with a ready flow to encourage good feeding. As baby gets used to this new system you can lower the bottle and encourage more active feeding.
In addition, you can pinch off the tube every few minutes and see if baby will continue to suckle on breast milk alone, releasing the flow if s/he becomes agitated or swallows disappear. Pinching the tube occasionally also helps to better mimic the natural ebb and flow of breastmilk and will reduce the risk of breast rejection.
Offering both sides with the SNS at every feed is ideal, but can be fiddly. It's fine to use the SNS on one side per feed and to plan to alternate the side you use it on from feed to feed.
If you have a lower supply on one side, you can prioritise SNS use on this side to stimulate an even better supply.
Purpose bought SNS kits will have cleaning instructions to follow.
NG tubes as part of a home-made SNS, used with expressed milk only, do not need to be sterilised each use. As with the pump kit, they can be kept in the fridge between uses and washed and cleaned once a day: Using a syringe, rinse through with hot soapy water to remove milk residue. Rinse again with clean water to remove soap. Finally push air through the tube using an empty syringe to dry the tube, or swing the tube around in the air to force the water out. If you wish to you can sterilise as per instructions for formula used tubes below.
NG tubes used with formula milk need to be sterilised after each use: Rinse through with hot soapy water to remove formula residue. Rinse through with sterilising fluid and leave for the required time. Rinse again with clean water to remove chemical residue, and flush through with air. Microwave or heat sterilisation can cause rapid degeneration of the tubes.

VIDEO

https://youtu.be/T1nZmxbEObs

More information on SNS use

Using Nipple Sheilds

Shields can be very helpful when used appropriately as a short-term intervention, though some families are able to use them for many weeks/months with no adverse effect on supply.
Having the right size shield for you and your baby is important. The majority of women will find a small or medium is a good fit. A few may benefit from a large siz, and a minority may need specialist fitting.
If baby is only feeding from a bottle, it can be more helpful to use a shield so that s/he gets used to being fed at the breast.
Shields give babies a similar feeding stimulus to the teat of a bottle, and they can mean it is easier for baby to maintain a latch, especially if s/he has tongue restrictions.
When working to increase supply or weight gain, it is best to offer both breasts at every feed, and even a 3rd and 4th breast (or more) if feeding still appears effective.
It is also a good plan to try to express after feeds if working to improve supply/eliminate formula. You may not get a large volume, but what you do get further increases your milk supply each time, and also makes a great fatty top-up
One shield can be used across both breasts through out a feed. The second shield of your pair can be used at the next feed.
As with expressing, although your shields need to be sterilised before first use, the can then simply be washed with hot soapy water in rinsed in hot water between uses. Many parents like to clean and sterilise once a day, storing the shields in the fridge between uses.